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Background: We sought to determine whether any relevant patient, fracture, surgical, or postoperative characteristics are associated with loss of reduction after plate fixation of isolated olecranon fractures in adults. Methods: Patients who underwent open reduction and internal fixation of an olecranon fracture at our institution over an 11-year period were analyzed. Electronic patient charts and radiographic images were reviewed to gather patient, fracture, surgical, and postoperative data. Statistical analysis to explore the differences between groups was performed. Results: Seven of 96 patients experienced a loss of fracture reduction diagnosed at a median of 19 days after their initial surgery (range: 4-116 days). The radiographic mode of failure of all patients who lost reduction was proximal migration of the proximal fracture fragment with or without implant failure. The group that lost reduction had a significantly smaller proximal fragment (14.2 vs 18.6 mm), a higher incidence of malreduction with a persistent articular step-off greater than 2 mm (6/7 vs 14/89), a greater distance between the most proximal screw and the olecranon tip (19.8 vs 13.5 mm), a higher proportion of constructs with screws placed outside of the primary plate (4/7 vs 14/89), and a higher proportion of patients that were not immobilized postoperatively (3/7 vs 8/89). Conclusions: Our results suggest anatomical reduction at the articular surface and adequate fixation of the proximal fragment are key factors in maintenance of reduction, with smaller proximal fragments being at higher risk for failure. A period of postoperative immobilization may decrease the risk of loss of reduction.

Background:Risk factors for removal of symptomatic hardware after plate fixation of olecranon fractures are not well defined. We examined patient, fracture, and surgical characteristics in relation to hardware removal for symptomatic instrumentation after plate and screw fixation of isolated olecranon fractures in adults. Methods:Eighty-four patients who underwent open reduction and internal fixation (ORIF) of isolated olecranon fractures with a plate and screw construct were analyzed retrospectively. Those with subsequent hardware removal for symptomatic hardware were identified. Charts and radiographs were reviewed to gather patient, fracture, and surgical characteristics in relation to management of their olecranon fracture. Univariate analysis was performed to test for statistical significance between groups. Results:Seventeen of 84 patients (20.2%) underwent hardware removal for symptomatic instrumentation at an average of 326 days after ORIF. Compared to patients who retained hardware, those who underwent removal trended younger (40.0 vs. 49.4 yr, P = 0.076), had a higher percentage of one particular plate design (35% vs. 8%, P = 0.026), and had their plate fixated an average of 1.3 mm farther from the olecranon tip (3.4 vs. 2.1 mm; P = 0.011). There was an 8.2 times increased likelihood of hardware removal for plates that were placed more than 2 mm from the olecranon tip [1.7 to 38.7, 95% confidence interval (CI); P = 0.003]. Conclusions:This study resulted in approximately 20% rate of symptomatic hardware necessitating removal. Patients who request removal tend to be younger. Fixating the plate closer to the olecranon tip may decrease the incidence of symptomatic hardware and need for subsequent removal.

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